The most common types of breast revision surgeries are augmentation revision, implant removal and breast lift (mastopexy) revision. Techniques may be combined for patients who had more than one primary breast surgery or whose concerns require a multi-part approach.
BREAST AUGMENTATION REVISION
Augmentation revision most often seeks to exchange implants that are too large, too small, unnatural-looking or -feeling, damaged or poorly healed. Augmentation revision surgery may also improve the appearance of visible scarring in some cases. Patients may pursue augmentation revision as soon as they have recovered from their primary surgery, or they may choose revision years later as their results or their aesthetic preferences change over time.
Along with the option of exchanging the breast implant, there are exciting new technologies such as Strattice grafts, SurgiMend grafts and Flex HD grafts. These may help with correcting capsular contracture (firmness of the breast mound), visible rippling or edges of a breast implant or an implant that has dropped lower on the chest wall. These grafts are made from skin tissue that has all the cellular material removed. They can serve as padding for the implant or can hold the implant in place.
During a breast augmentation revision, your surgeon will most often use the same incisions from your primary surgery to access your breast tissue and implants. This prevents adding more visible scarring and allows your surgeon to improve the appearance of scars that healed poorly. Your surgeon will then be able to address your concerns. Approaches may include:
- Opening a contracted scar tissue capsule to release the tension around the implant (capsulotomy)
- Removing the implant and scar tissue capsule entirely (capsulectomy)
- Replacing a damaged breast implant with an identical, undamaged one
- Replacing the breast implant with a different one of the patient’s preferred size, shape or material
- Moving the breast implant and securing it in place with a graft to ensure symmetry and ideal implant placement
- Adding a graft to increase padding between the implant and the skin
BREAST IMPLANT REMOVAL
Some women are unhappy with their breast implants and simply want to remove them rather than exchange them. This may be due to a change in lifestyle or preference that has caused the woman to feel more comfortable with smaller, natural breasts. It may be due to poor experiences with augmentation or augmentation revision, as some women’s bodies have a more difficult time healing with good results. This surgery can be challenging, particularly when removing larger implants, as the skin is sometimes stretched and can leave behind a sagging, deflated look if performed without great care. In some instances, your surgeon may suggest choosing a smaller implant to prevent an unsatisfactory outcome. Your Advanced Aesthetics surgeon will help you understand your possible results and your best options.
Recently, some patients have been more interested in breast implant removal due to news about breast implant illness. Whether the patient is experiencing symptoms or is worried about developing symptoms, she may feel that she does not want the risk of having implants in her body.
We want to reassure patients that smooth breast implants are not currently a cause for concern, and that the FDA has not yet made a recommendation that asymptomatic patients with textured breast implants have them removed. As always, though, Advanced Aesthetics’ primary concern is the safety of our patients. We will not be using textured implants or tissue expanders moving forward, and we would be happy to discuss concerns about such devices with you. We welcome any of our patients or any new patients to please call us with any questions so we can provide you with the latest updates. We would also ask you to consider making an appointment to discuss any concerns in more detail.
During a breast implant removal surgery, your surgeon will access the breast tissues and implant along the same incisions from your first procedure. Then, your surgeon will perform all adjustments necessary to meet your needs, including:
- Carefully removing the implant and the scar tissue capsule
- Trimming away stretched or excess skin
- Repositioning the nipple-areola complex
- Repositioning remaining natural breast tissue
BREAST LIFT REVISION
Breast lift revisions are most often performed to correct asymmetries or noticeable scarring that has occurred during the breast lift healing process. Due to the donut, lollipop or anchor scar techniques used during a breast lift, most women have visible scarring around the areola and/or vertically between the areola and the inframammary fold. Sometimes these scars heal unevenly, leaving the nipple-areola complexes asymmetrical or misshapen. In other cases, the “lift” of both breasts is asymmetrical, with one breast noticeably higher on the chest wall than the other.
Additionally, some women choose to undergo another breast lift several years after the first as their breasts have naturally drooped further over time. Although this may seem like a second primary breast lift as opposed to a revision, we would still recommend seeing a surgeon who has experience with breast lift revisions. They will know how to best perform the procedure while factoring in the results of the first surgery.
A breast lift revision typically uses the same incisions from the first lift, though extra incisions may be used if the surgeon requires more access to breast tissues (e.g., using a lollipop incision for a patient whose prior lift used a donut technique). Your surgeon may include any of the following in your surgical plan to address your particular concerns:
- Reshaping and resuturing the incision around the areola to improve shape and symmetry
- Repositioning breast tissue for breast projection and position
- Repositioning breast tissue for improved symmetry
- Centering the nipple-areola complex on the breast
- Using a Strattice, SurgiMend, Flex HD or similar graft to better support breast tissue internally
- All incisions will be carefully closed to ensure even healing, and your surgeon will give you detailed aftercare instructions to minimize discoloration or unevenness in your scars.
